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General NPI Number Information
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NPI Number | 1245438027
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Entity Type | Individual
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Provider Name | KIRBY E BONNER PTA
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Gender | Female
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Dates
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Enumeration Date | 07/03/2007
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Last Update Date | 07/17/2013
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Provider Practice Location Address
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Address Line | 600 REUNION CT
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City | GRANBURY
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State | TX
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Zip | 76048-1610
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Country | US
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Telephone | 817-573-3773
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Fax |
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Provider Business Mailing Address
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Address Line | 3004 KAREN WAY
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City | GRANBURY
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State | TX
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Zip | 76049-2989
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Country | US
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Telephone | 304-376-1812
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA001299
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA21595
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2075579
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License Number State | TX
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